Quarter 4 Direct Care Workforce Funding Attestation and Survey Due October 14.
To be eligible for future direct care workforce payments, providers must complete the Quarter 4 attestation and survey by October 14, 2019 (this has been extended from September 13).
Below are frequently asked questions about the long-term care Direct Care Workforce Funding Initiative. If you have additional questions or comments, please email us.
The Wisconsin legislature included a $60.8 million provision in the state’s 2017-19 biennial budget, enacted as 2017 Act 59, to fund increases for the direct care portion of managed long-term care capitation rates.
The Wisconsin Department of Health Services (DHS) held meetings with managed care organizations (MCOs), providers, associations, and advocates between December 2017 and February 2018 to develop and receive feedback on a distribution proposal. The proposal was approved by the Centers for Medicare & Medicaid Services (CMS).
What employees are considered direct care workers?
For the purposes of the Direct Care Workforce Funding Initiative, a direct care worker is defined as an employee who contracts with, or is an employee of, an entity that contracts with an MCO to provide:
- Adult day care services.
- Daily living skills training.
- Habilitation services.
- Residential care (adult family homes of 1–2 beds, adult family homes of 3–4 beds, community-based residential facilities, residential care apartment complexes).
- Respite care services provided outside of a nursing home.
- Supportive home care.
A direct care worker also provides one or more of the following services through direct interaction with members:
- Assisting with activities of daily living or instrumental activities of daily living
- Administering a member’s medications
- Providing personal care or treatments for a member
- Conducting activity programming for a member
- Provides services such as food service, housekeeping, or transportation to the member
Staff not in the definition of direct care worker include, but are not limited to:
- Licensed practical nurses, registered nurses, and nurse practitioners.
- Nursing home staff and personal care agency staff.
- Staff in marketing, sales, reception, finance, or maintenance and plant operations.
- Staff who work exclusively in food service, transportation, and housekeeping and do not have direct contact with members.
How will the amount of funding each provider receives be determined?
DHS will determine the specific quarterly amount each provider is eligible to receive. Since participation is voluntary, some providers may decline the funding.
The amount of funding each provider is eligible to receive will be calculated as follows:
- DHS divides the funds into four quarterly amounts, one for each quarter of calendar year (CY) 2018.
- Next, DHS divides the amount for each quarter by the total MCO payments to direct care providers for the quarter. This determines the percentage increase all direct care providers will receive. For this calculation, DHS assumes all providers are participating in the initiative.
- Finally, DHS multiplies the percentage increase by the payments each provider received during that quarter from the MCO it contracts with. The result determines the payment amount to each provider.
If DHS calculates a 1% increase for all providers and one specific provider received a total of $30,000 from an MCO in quarter 1 of CY 2018, that provider would receive an additional payment of $300 from the MCO.
How will funding be distributed?
DHS calculates the amount each provider will receive and pays that amount to the MCOs for Family Care, Family Care Partnership, and PACE.
MCOs will be contractually obligated to pay providers the entire direct care workforce payment received from DHS.
Providers will receive a payment from each MCO contracted with during the quarter. Providers then pay their direct care workers using the entire direct care workforce funding received from MCOs.
How many payments will there be?
There will be four main payments and one final payment in May 2020. The May 2020 payment will redistribute any funds MCOs returned to DHS because providers chose not to participate or were not compliant with completing the Direct Care Workforce Funding Attestation and Surveys.
What is the timing of payments to MCOs?
The payment schedule to MCOs is in the following table. In addition, there will be a final payment by May 15, 2020, to redistribute any funds MCOs return to DHS because providers chose not to participate.
|Quarterly Payment||Payment Made to MCO||Dates of Service|
|Quarter 1||June 29, 2018||January 1–March 31, 2018|
|Quarter 2||September 28, 2018||April 1–June 30, 2018|
|Quarter 3||December 21, 2018||July 1–September 30, 2018|
|Quarter 4||June 28, 2019||October 1–December 31, 2018|
When will the first payments be allocated to MCOs?
DHS will make the first payments to MCOs by June 29, 2018.
When will providers start to see direct care workforce payments from MCOs?
Below are the deadlines for MCOs to distribute funds to providers.
Quarter 1: August 15, 2018
Quarter 2: October 31, 2018
Quarter 3: January 31, 2019–This deadline has been extended to April 10, 2019.
Quarter 4: July 31, 2019–This deadline has been extended to October 14, 2019.
Final: May 15, 2020
Which providers will receive the funding?
Providers of adult day care services, daily living skills training, habilitation services, residential care (adult family homes of 1–2 beds, adult family homes of 3–4 beds, community-based residential facilities, residential care complexes), respite care provided outside of a nursing home, and supportive home care services.
- Providers of self-directed services
- Nursing homes, personal care agencies, and MCOs
- Providers that decline to participate in this voluntary program
- Providers that discontinue operations or go into bankruptcy
How will MCOs be held accountable for distributing the funding?
DHS will monitor that the direct care workforce funding amount MCOs pay to each provider matches the amount DHS calculated each provider should receive.
After each payment, MCOs will be required to attest they paid the direct care workforce funding to providers.
What are the distribution requirements for providers?
Sign a Contract With MCO
The provider must sign a contract to receive funding from the MCO. The provider must have an active contract with the MCO at the time the funds are distributed. To be eligible for the first quarterly payment, the provider must sign and return the direct care worker provider agreement, and the MCO must receive it within 45 days of the date the MCO originally sent the agreement.
Distribute Funding and Complete Online Attestations and Surveys
Providers are required to distribute funding to direct care workers and complete Quarter 1 through Quarter 4 online attestations and surveys by the following deadlines:
Quarter 1: September 14, 2018. Complete the Quarter 1 attestation and survey now.
Quarter 2: December 15, 2018 (extended to February 15, 2019). Complete the Quarter 2 attestation and survey now.
Quarter 3: April 30, 2019 (extension): Complete the Quarter 3 attestation and survey now.
Quarter 4: September 13, 2019 (extended to October 14, 2019). Complete the Quarter 4 attestation and survey now.
In the online survey, providers will be required to report how they paid the funding to direct care workers. Examples include wage increases, bonuses, or additional paid time off for direct care workers.
Providers will also need to keep documentation identifying the precise amounts paid to each direct care worker.
What happens if a deadline is missed?
Providers who miss the quarterly deadline for the online survey and attestation will not be eligible for future direct care workforce payments. Providers who do not complete an online survey and attestation by September 13, 2019, will have the funding they received recouped by the MCO.
Will providers receive the same amount of funding each quarter?
No. The amount of funding a provider receives depends on many factors, including how many Family Care and Family Care Partnership members a provider serves; the payments they receive from MCOs; and payments all other direct care providers receive from MCOs.
How can providers use the funding?
Providers may use the funding to:
- Provide wage increases, bonuses, and/or additional paid time off to direct care workers.
- Pay for employer payroll tax increases that result from increasing workers' wages.
Other uses of the funding are not allowed.
Are owner-occupied adult family homes eligible for direct care workforce funding, even if the owner is the only direct care worker at the facility?
Yes. Owner-occupied adult family homes are providing direct care and therefore are eligible for the direct care workforce funding.
Must providers give the direct care workforce funding to staff who provide services only to Family Care or Family Care Partnership?
No. DHS does not expect providers to have dedicated staff for clients on Medicaid. Any direct care worker that provided services to a Family Care and Family Care Partnership member in Wisconsin may receive the funding.
Do providers need to spend more than the direct care workforce funding they receive to keep all staff at the same wage or bonus increase?
No. Providers are not required to spend more than the direct care workforce funding. Providers may choose which direct care workers receive the funding, as long as the direct care worker has provided services to a Family Care and Family Care Partnership member in Wisconsin.